Utility of respiratory function tests in esophageal neoplasm

Introduction and objectives: Complications are numerous in esophageal surgery, especially pulmonary, being the main cause of postoperative morbidity and mortality, therefore a good respiratory functional assessment is essential to reduce them but there are little literature on how to perform preoperative functional assessment.

Material and methods: Two-year prospective and observational study, with a cohort of 46 patients with early diagnosis of esophageal neoplasm, who were referred to our Unit for functional tests (preoperative assessment). Clinical data, respiratory function tests and cardiopulmonary exercise stress test on bicycle ergometer were taken into account. In the absence of defined criteria to calculate the postoperative values for this type of surgery, a risk similar to that corresponding to a mean lobectomy was considered using the Alessandro Brunelli et al scheme of the American College of Chest Physicians (ACCP).

Results: Forty-six cases were evaluated with an accumulated average tobacco consumption of 43.2 ± 17.5 pack/year. 78.3% were males. The average age of the intervened patients was 61.7 ± 8.1 years and the non-intervened patients 73 ± 6.8 years, (p < 0.05). Operated patients present better functional tests (p < 0.05). There were 13 patients with moderate risk and 10 with low risk, no case of high risk. The survival was 15 ± 11.4 months in both groups without statistical significance.

Conclusion: Operated patients had a better clinical and respiratory situation. Functional evaluation can reduce postoperative complications thanks to an adequate selection of patients at high surgical risk. A study with a larger number of patients will allow us to perform an algorithm with specific functional criteria for patients that are subsidiary to this type of surgery.

Table 1 

	Half	Typical deviation
Age	64.34	9.31
Weight (kg)	71.24	12.36
Size (cm)	165.58	9.01
Actual FEV1 (ml)	2545	881
FEV1 (%)	81.38	19.06
Actual DLCO (ml CO/min/mmHg)	6.36	2.26
DLCO (%)	80.15	26.53
VO2max (ml/min)	941.92	273.85
VO2max (%)	54.78	16.53
FEV1 ppo (ml)	2226.87	788.27
FEV1 ppo (%)	71.75	17.33
DLCO ppo (ml CO/min/mmHg)	5.60	1.84
DLCO ppo (%)	71.80	20.07
VO2max ppo (ml/min)	828.89	241.09
VO2max ppo (%)	48.92	12.85
VO2max ppo (ml/min/kg)	9.39	0.55

Table 2 

	Intervened		Not intervened
	Half	Typical deviation	Half	Typical deviation
Age	61.74	8.15	73.00	6.81
Weight (kg)	72.18	11.32	67.38	12.64
Size (cm)	165.59	8.65	165.08	11.07
Actual FEV1 (ml)	2750	852.38	2020	875.76
FEV1 (%)	86.95	16.72	66.90	20.62
Actual DLCO (ml CO/min/mmHg)	6.62	1.93	5.67	1.91
DLCO (%)	77.59	26.77	72.66	21.22
VO2max (ml/min)	985.48	311.42	858.75	217.74
VO2max (%)	54.35	18.58	60.13	17.82
FEV1 ppo (ml)	2460.65	758	1777	770.67
FEV1 ppo (%)	77.48	15.14	58.80	18.25
DLCO ppo (ml CO/min/mmHg)	5.92	1.74	4.91	1.62
DLCO ppo (%)	72.38	17.02	58.80	18.25
VO2max ppo (ml/min)	867.24	274.23	755.75	191.58
VO2max ppo (%)	49.05	13.25	53.13	15.74
VO2max ppo (ml/min/kg)	10.90	0.51	8.25	0.62
Survived	15.83	11.20	15.00	11.04